Despite wonderful advances electronic health record (EHR) technology eventually will bring, today’s systems have some serious flaws. (See my earlier post here on one of them.)
I recently had a personal run-in with another not-ready-for-primetime EHR feature: The system used by a major health care facility – an ‘academic medical center,’ according to its website – is described by the office of at least one physician there as “the best way to interact with your medical team.” There’s a very good chance that would be so, if there were a way for [a] providers to be advised/alerted when a patient sends in a message, and [b] patients to be notified – ideally by email, alternatively by an automated phone call – when a message is sent to them, their chart is updated, or an appointment needs to be rescheduled. (The latter presently are handled by U.S. Mail, a slow, unnecessarily-costly approach to communications of this sort in the year 2016!)
Jim Schroeder, a pediatric psychologist – perhaps one of the least-known specialties in medicine! – had a lot to say on this EHR flaw and others in a recent by-lined article on the KevinMD.com website. The basic problem, he said, revolves around what’s called “meaningful use” – “defined as using EHR technology to improve quality, safety, efficiency, and reduce health disparities.”
“The promise,” he went on, “is that meaningful use will help improve patient and provider communication and increase coordination while maintaining the privacy and confidentially of patients.”
He says this is impacting his highly specialized practice, actually “decreasing efficiently and staff/patient communications,” as he put it. Imagine, then, the types, levels and degrees of communication breakdowns cited in the second paragraph (above) are having across the broad swath of specialties – not to mention the practices of primary care physicians (PCPs) where EHRs are being introduced and even mandated.
Even something as straight-forward as this appointment-fixing system really breaks down, all too often, because neither the medical staff nor the patient is prompted – in a way suggested above – that ‘the other side’ is reaching out to effect a change. Complicating factors, Dr. Schroeder points out in his article, are instances where a medical practice staffer has been temporarily or permanently reassigned and no one is designated, in their absence, to check the incoming mail ‘bucket’.
And, he notes, it gets worse:
But beyond the purely practical issues, there are psychological factors at play that likely speak to increased stress, burnout, and turnover that many are experiencing. The first issue is that we, the staff and providers, are increasingly being disjointed by all the options available. Previously in our office the only place a staff member had to monitor for potential cancellations was the phone lines; now suddenly, there are multiple circuits that they are responsible for checking, which increases the already fragmented nature of the position.
Previously when patients wanted to send a message, it could only [be done] in person, by phone, or by fax (or mailed letter); now, the electronic avenues being utilized (or explored) are growing exponentially in addition [to] the traditional ones that [still] exist.
It seems wonderful for patients to be able to communicate through whichever way they desire. That is, until the communication becomes so scattered and decentralized that it repeatedly breaks down.
A second principle of concern is what I will call the “psychological distance X amount of information received” ratio. Basically described, the further removed a communication gets from a direct, face-to-face interaction, the more contacts [are likely to be necessary]. Effort also interacts with this principle, as the more effort a message takes, the less likely it will [accomplish the intended objective].
Take a simple illustration: Most patients do not show up at your office to convey a message. A few might send a letter. Some will call. But open the lines of electronic access, whether they be through a portal, email, text or otherwise, and what you will find is that your messages will only start increasing. Thoughts/worries that patients may have not felt were significant enough issues to justify a phone call or face-to-face meeting will now much more likely be transmitted. … Suddenly, everyone seems to have something to say!
Whereas people may have previously communicated a message to their friends through a few phone calls, now hundreds of texts might be sent.”
Dr. Schroeder says he wants his patients to be able to communicate with him effectively, for their health and his ‘quality of practice’. But there is no way, he says, “[that] I can sustain my professional and personal life the way I should if the messages only increase from what already exist.
“Meanwhile, as EHR is supposedly creating a more efficient circumstance for all providers, we are finding that internal medicine residents are spending an average of five hours per day on electronic charts. Is this really patient-centered, person-centered practice and learning done more efficiently?
I appreciate many of the advantages that technology has provided at work and home. But as EHR and other systems further develop, it seems that technology is guiding people instead of people guiding technology. Simply because a capacity exists does not mean it is best practice, or should be employed at all. Simply because we are a consumerist health care industry does not mean that patients should be afforded every means possible to dictate how they communicate their health care needs. Sometimes, even the tedious act of calling an office to communicate a message or reschedule an appointment is way more important than we think, and more efficient than we realize.
I am not saying this just as a licensed psychologist. I am saying this as a married father of six young children. Because when we get to the heart of the matter, I am first and foremost responsible for the people I pledge to love, care for and work with. Technology may just have to wait.
While I fully appreciate and empathize with Dr. Schroeder’s concerns, which are very real, increasingly more real ones, it’s hard to avoid thinking that, in a way, this doctor ‘doth protest too much’: Six young children? So much for his time stresses!
(The late comedian Groucho Marx had a radio, then televised, quiz program called ‘You Bet Your Life’. In its earlier days, it was broadcast live – dangerous at the best of times, where Groucho was concerned, as he was always prone to say the first thing that popped into his mind – or which effectively by-passed his mind on its way to his mouth.
(He once had a contestant, a woman, who said, responding to his general warm-up questions, that she had a lot of children. (The precise number is lost in the mists of time – and it’s irrelevant, anyway. Numbers as high as 14 have been tossed around.) She responded, “Because I love my husband.”
(Groucho, who nearly always had a trademark cigar in his face and a leer on his lips, said, without missing a beat, “I love my cigar, too, but I take it out of my mouth once in a while!”)
I envision a day, not too far in the future, when medical offices will have to have a staffer whose prime responsibility is capturing in-coming electronic messages, getting answers for them, and doing the responding doctors and nurses simply don’t have time to do – not to mention, electronic message-answering isn’t in their job description.
I will be very appreciative if you will encourage your friends, family and colleagues to check out what my two blogs – Food TradeTrends.com and YouSayWhat.info – do in the interest of providing information you might, otherwise, never become aware of. You never know: Some of my research could prove useful, or possibly amusing, to you, and/or them.